Non-metastatic disease may be either an invasive mole or choriocarcinoma and is defined as having no disease outside the uterus .
Standard Treatment Chemotherapy for an invasive mole and non-metastatic choriocarcinoma is the same. All cases of non-metastatic GTD are considered curable, even if there is extensive local disease. If chemotherapy fails, a hysterectomy is usually performed.
The standard treatment is with a single chemotherapeutic drug. Most physicians use methotrexate if the liver functions are normal or actinomycin-D if they are not. Methotrexate is given daily, either by injection into a muscle or intravenously, for five days. This schedule is repeated every 14 days until the ßHCG level returns to normal. Three or four courses are usually required.
Methotrexate may also be given on Days 1, 3, 5 and 7 with leucovorin (folinic acid) given on Days 2, 4, 6 and 8. When used in this fashion, only one course of treatment is given (with a cure rate of around 80 percent). A second or third course is given only if the ßHCG titer does not return to normal.
Actinomycin-D is usually given intravenously for five consecutive days and repeated every two weeks. If treatment with methotrexate fails to bring about ßHCG remission , actinomycin-D is given (or vice versa).
